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Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts
H Le Breton1, D Pavin, T Langanay
1Department of Cardiology, CHRU Hotel Dieu, Rennes, France.
Insights
Aneurysms in saphenous vein grafts after coronary artery bypass surgery are rare but serious complications. These graft aneurysms can cause chest pain and may require surgical or endovascular treatment.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for coronary artery disease.
- Saphenous vein grafts (SVGs) are frequently used conduits in CABG.
- Aneurysms developing in SVGs are uncommon but recognized complications.
Observation:
- Three male patients presented with spontaneous chest pain 10, 21, and 17 years post-CABG.
- One patient developed a fistula between the SVG and the right atrium due to graft erosion.
- Symptoms manifested years after the initial bypass surgery.
Findings:
- Diagnosis of saphenous vein graft aneurysms was confirmed using echocardiography, CT/MRI, and arteriography.
- The aneurysms represented a delayed complication of the bypass procedure.
- Clinical presentation included significant chest pain and, in one case, cardiac erosion.
Implications:
- This case series highlights the potential for late-onset aneurysmal degeneration of SVGs.
- Early diagnosis and appropriate management are crucial for preventing serious complications.
- Treatment strategies include surgical repair and endovascular interventions like embolization and angioplasty.
Abstract:
Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.